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Proactive quality improvement strategies to  endoscope processing are necessary to ensure patient safety, according to a review published in the American Journal of Infection Control. The review, conducted between 2019 and 2024, found high-level disinfection did not reliably eliminate microbes in real-world settings. A large proportion of endoscopes still contained “substantial bioburden and potential pathogens.” When contaminated endoscopes or endoscopy-associated infections occurred, investigators often found personnel skipped essential steps or did not do them correctly. The authors call for infection preventionists, clinicians, sterile processing and department managers and other leaders to review the evidence, perform risk assessments and implement proactive strategies for quality improvement in their organizations. (American Journal of Infection Control , 4/8/25)